PEDIATRICS Vol. 118 No. 1 July 2006, pp. 91-100 (doi:10.1542/peds.2005-2343)
Neuropsychological Outcome of Children With Intrauterine Growth Restriction: A 9-Year Prospective Study
a Institute for Child Neurology and Neurology Unit, Dana Childrens Hospital, Souraski Medical Center, University of Tel Aviv, Tel Aviv, Israel
b Psychology Department, Developmental Neuropsychological Laboratory, Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
OBJECTIVE. The aim was to evaluate the effect of late-onset intrauterine growth restriction on the neuropsychological profile and on academic achievements at 9 years of age using a large-scale prospective paradigm.
STUDY DESIGN. We followed up 123 infants diagnosed with late-onset intrauterine growth restriction yearly for 9 years. They were matched with 63 children for gestation age and multiple socioeconomic factors and evaluated by an extensive neuropsychological battery to assess intelligence quotient, academic achievements, learning and memory, visuomotor skills, visuospatial integration, attention, language, executive functions, and creativity.
RESULTS. Children with intrauterine growth restriction had lower intelligence quotient and more frequent neuropsychological difficulties. Difficulties in executive functioning, inflexibility-creativity, and language, indicative of frontal lobe dysfunction, were typically affected by intrauterine growth restriction and were rarely identified in the control group. Learning difficulties accompanied by lower academic achievements were more prevalent in the intrauterine growth restriction group, particularly when anthropometric catch-up was incomplete.
CONCLUSIONS. The longitudinal findings reaffirm that functional coherence depends on preestablished structural growth and reorganization of the central nervous system. The neuropsychological profile at 9 years of age indicates that late-onset intrauterine growth restriction compromises frontal network functioning.
Key Words: outcomes of high-risk infants neurocognitive long-term follow up executive function/dysfunction intrauterine growth retardation
Abbreviations: BSPbrain-sparing process CIcephalization index IUGRintrauterine growth restriction BWbirth weight CNScentral nervous system IQintelligence quotient EGAestimated gestational age WISC-R95Wechsler tests of intelligence-revised ROCFRey-Osterrieth Complex Figure NEPSYNeuropsycholological Evaluation for Children HChead circumference ANOVAanalysis of variance NSnot significant CUGcatch-up growth AGAappropriate-for-gestation age
Accepted Jan 19, 2006.
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